Publications by authors named "Maryam Akhgari"

26 Publications

  • Page 1 of 1

A cross-sectional multicenter linkage study of hospital admissions and mortality due to methanol poisoning in Iranian adults during the COVID-19 pandemic.

Sci Rep 2022 06 13;12(1):9741. Epub 2022 Jun 13.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

A methanol poisoning outbreak occurred in Iran during the initial months of coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate the epidemiology of the outbreak in terms of hospitalizations and deaths. A cross-sectional linkage study was conducted based on the hospitalization data collected from thirteen referral toxicology centers throughout Iran as well as mortality data obtained from the Iranian Legal Medicine Organization (LMO). Patient data were extracted for all cases aged > 19 years with toxic alcohol poisoning during the study period from February until June 2020. A total of 795 patients were hospitalized due to methanol poisoning, of whom 84 died. Median [interquartile ratio; IQR] age was 32 [26, 40] years (range 19-91 years). Patients had generally ingested alcohol for recreational motives (653, 82.1%) while 3.1% (n = 25) had consumed alcohol-based hand sanitizers to prevent or cure COVID-19 infection. Age was significantly lower in survivors than in non-survivors (P < 0.001) and in patients without sequelae vs. with sequelae (P = 0.026). Twenty non-survivors presented with a Glasgow Coma Scale (GCS) score > 8, six of whom were completely alert on presentation to the emergency departments. The time from alcohol ingestion to hospital admission was not significantly different between provinces. In East Azerbaijan province, where hemodialysis was started within on average 60 min of admission, the rate of sequelae was 11.4% (compared to 19.6% average of other provinces)-equivalent to a reduction of the odds of sequelae by 2.1 times [95% CI 1.2, 3.7; p = 0.009]. Older patients were more prone to fatal outcome and sequelae, including visual disturbances. Early arrival at the hospital can facilitate timely diagnosis and treatment and may reduce long-term morbidity from methanol poisoning. Our data thus suggest the importance of raising public awareness of the risks and early symptoms of methanol intoxication.
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http://dx.doi.org/10.1038/s41598-022-14007-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9189800PMC
June 2022

Highly efficient dispersive liquid-liquid microextraction assisted by magnetic porous carbon composite-based dispersive micro solid-phase extraction for determination of tramadol and methadone in urine samples by gas chromatography-mass spectrometry.

J Chromatogr A 2022 May 21;1670:462989. Epub 2022 Mar 21.

Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.

The recognition of opioids, either as prescription drugs or illicit narcotics, is one of the hot challenges in the analytical field, especially in forensic medicine. Here, a rapid and high efficient air-assisted dispersive liquid-liquid microextraction (DLLME) running after a dispersive magnetic solid-phase extraction (MSPE) is developed for simultaneous extraction and preconcentration of tramadol and methadone in urine samples prior to gas chromatography-mass spectrometry (GC-MS) determination technique. The samples were first mixed with a new magnetic and porous adsorbent, based on a metal-organic framework (MOF) derived NH-functionalized FeO nanoparticles-carbon nanocomposite ([email protected]). Then, the eluent, containing the retrieve analytes, was directly applied as the disperser solvent, along with dichloromethane extracting solvents, to perform DLLME. The combination of MSPE, using the new high surface area sorbent, with a high-performance DLLME resulted in exceptional enrichment factors and extraction recoveries. Under the optimized conditions, linear ranges of 0.1-30 ng mL and 0.1-35 ng mL, and detection limits of 73 and 32 pg mL, were obtained for tramadol and methadone, respectively. The developed system was utilized for the extraction and preconcentration of tramadol and methadone in some urine samples of suspected drug users, with a reasonable reproducibility (2.4-4.5%). The results were in good agreement with those of the official HPLC/MS-MS technique.
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http://dx.doi.org/10.1016/j.chroma.2022.462989DOI Listing
May 2022

Psychotropic drug abuse in pregnancy and its impact on child neurodevelopment: A review.

World J Clin Pediatr 2022 Jan 9;11(1):1-13. Epub 2022 Jan 9.

Legal Medicine Research Center, Legal Medicine Organization, Tehran 1114795113, Iran.

Substance abuse by women of child-bearing age and fetal in utero drug exposure has increased in the number of infants born with health issues. Prenatal exposure to psychoactive substances can lead to neurological and neurodevelopmental deficits later in life. Useful data concerning the effects of psychoactive drugs on fetal neurodevelopmental status are sparse. Understanding the neurodevelopmental consequences of prenatally drug-exposed children has become a pressing global concern. The aim of this review is to gather current evidence and information on neurodevelopmental outcomes of in utero drug exposure. A literature search was performed on the PubMed, Scopus, and Google Scholar databases using the terms "psychotropic drugs", "neurodevelopmental consequences", "prenatal drug exposure", and "pregnancy". Available studies on in utero drug exposure were reviewed and found to support the idea that some degree of health issues are present in fetuses and children. Different psychoactive substances have profound neurodevelopmental consequences, such as structural brain changes, poor attention span, Down syndrome, attention deficit hyperactivity disorder, autism spectrum disorder, imbalances in neurotransmitter levels, and many structural deficits. The pervasive use of psychoactive drugs in women of child-bearing age is an important health concern. Further scientific efforts are needed to investigate the effect of prenatal exposure to psychoactive drugs on children.
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http://dx.doi.org/10.5409/wjcp.v11.i1.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8771314PMC
January 2022

Post-mortem blood lead analysis; a comparison between LeadCare II and graphite furnace atomic absorption spectrometry analysis results.

J Forensic Leg Med 2022 Feb 22;86:102317. Epub 2022 Jan 22.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Purpose: A comparison of the LeadCare II (LCII) point-of-care (POC) device with the gold standard graphite furnace atomic absorption spectroscopy (GFAAS) device was done in the context of post-mortem blood lead concentrations to determine comparability for screening value.

Methods: Consecutive autopsy cases from March 2018 to March 2019 were examined by the forensic medicine center. Blood samples with lead concentrations <10 μg dL by LCII analysis were excluded from GFAAS analysis. Samples were collected from femoral veins or cardiac chambers. Bland-Altman analysis was conducted to evaluate the agreement between both GFAAS and LCII lead values. Linear regression modeling was performed to predict GFAAS results based on LCII results. Five-hundred post-mortem blood samples were evaluated by LCII for blood lead. For 46 cases with LCII blood lead level (BLL) values more than 10 μg dL, further analysis was performed by GFAAS.

Results: Mean difference of BLL between the two methods was 5.92 μg dL (SD = 7.51; range: -14 to 23.7). GFAAS BLL values were significantly higher than LCII values (p = 0.029). Moreover, substance-user samples had significantly higher GFAAS BLLs (p = 0.006; mean difference = 11.62 μg dL). A significant regression equation was found (F [1, 44] = 108.44, p < 0.001, with an R2 of 0.711). Based on Bland-Altman plot averages for both predicted GFAAS BLL and measured GFASS BLL showed a mean difference was 0.014 (SD = 7.51; range: -17.9 to 20).

Conclusion: In conclusion, on post-mortem BLL samples, LCII and GFAAS show favorable correlation. LCII can be used as a screening technique for post-mortem blood lead analysis.
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http://dx.doi.org/10.1016/j.jflm.2022.102317DOI Listing
February 2022

COVID-19 pandemic and methanol poisoning outbreak in Iranian children and adolescents: A data linkage study.

Alcohol Clin Exp Res 2021 09 6;45(9):1853-1863. Epub 2021 Sep 6.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: During the first wave of COVID-19, many Iranians were poisoned by ingesting hand sanitizers and/or alcoholic beverages to avoid viral infection. To assess whether the COVID-19 pandemic resulted in an increased prevalence of accidental hand sanitizer/alcoholic beverage exposure in children and adolescents, we compared pediatric hospitalization rates during COVID-19 and the previous year. For poisoning admissions during COVID-19, we also evaluated the cause by age and clinical outcomes.

Methods: This retrospective data linkage study evaluated data from the Legal Medicine Organization (reporting mortalities) and hospitalization data from nine toxicology referral centers for alcohol-poisoned patients (age 0 to 18 years) for the study period (February 23 to June 22, 2020) and the pre-COVID-19 reference period (same dates in 2019).

Results: Hospitalization rates due to ethanol and methanol exposure were significantly higher in 2020 (n = 375) than 2019 (n = 202; OR [95% CI] 1.9 [1.6, 2.2], p < 0.001). During COVID-19, in patients ≤15 years, the odds of intoxication from hand sanitizers were significantly higher than from alcoholic beverages, while in 15- to 18-year-olds, alcoholic beverage exposure was 6.7 times more common (95% CI 2.8, 16.1, p < 0.001). Of 375 children/adolescents hospitalized for alcoholic beverage and hand sanitizer exposure in 2020, six did not survive. The odds of fatal outcome were seven times higher in 15- to 18-year-olds (OR (95% CI) 7.0 (2.4, 20.1); p < 0.001).

Conclusion: The Iranian methanol poisoning outbreak during the first wave of COVID-19 was associated with significantly increased hospitalization rates among children and adolescents-including at least six pediatric in-hospital deaths from poisoning. Public awareness needs to be raised of the risks associated with ingesting alcoholic hand sanitizers.
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http://dx.doi.org/10.1111/acer.14680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653331PMC
September 2021

Environmental assessment of pediatric Lead exposure in Tehran; a prospective cross-sectional study.

BMC Public Health 2021 07 21;21(1):1437. Epub 2021 Jul 21.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Ingestion and inhalation are common routes of exposure for lead in humans. Developing countries still have unacceptably high rates of lead toxicity, especially in children. Studies on probable risk factors of lead poisoning in Iranian children are insufficient. In this study, we aimed to evaluate possible environmental factors in children with high blood lead concentrations living in Tehran and neighboring cities.

Methods: In a prospective cross-sectional study between March 2018 and March 2019 we followed all children referred from two pediatric gastrointestinal clinics with blood lead level (BLL) > 5 μg/dL in metropolitan Tehran to investigate possible environmental risk factors in their home. Household specimens including scratched wall paint, house floor dust, windowsill dust, tap water, and consumed spice were evaluated using atomic absorption method to detect lead concentrations. Epidemiological and environmental data collected through in-depth interviews with parents/guardians. Industrial areas were defined based on municipality maps on industrial places.

Results: Thirty of 56 parents/guardians with BLL > 5 μg/dL agreed to be followed through environmental investigation. The only categorical statistically significant risk factor was a history of lead poisoning in the family and living in an industrial zone. There was a positive correlation between BLL and interior windowsills dust lead level, r = 0.46, p = 0.01. Scratched paint lead level and BLL showed a significant positive correlation, r = 0.50, p = 0.005. House floor dust lead level (median = 77.4, p < 0.001) and interior windowsill dust lead level (median = 291, p = 0.011) were both significantly higher than the environmental protection agency (EPA) standards of 40 μg/ft, 250 μg/ft. Interior windowsill dust lead concentrations were significantly higher in industrial areas (p = 0.026).

Conclusion: Children's playing environment should be cleaned more often to reduce dust. Moreover, specific rules may need to be implemented for paint lead concentrations and air pollution, especially in industrial areas.
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http://dx.doi.org/10.1186/s12889-021-11494-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296531PMC
July 2021

Trends in Poly Drug Use-associated Deaths based on Confirmed Analytical Toxicology Results in Tehran, Iran, in 2011-2016.

Addict Health 2021 Jan;13(1):18-28

Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.

Background: Poly drug use is a public health threat causing morbidity and mortality all over the world. Combined use of licit and illicit drugs is among the possible causes of death. In this retrospective analytical study, we evaluated forensic toxicology analysis results from 2011 to 2016 in Tehran province, Iran.

Methods: All deaths related to poly drug use and referred to the Legal Medicine Organization, Tehran during the 6-year study period were evaluated. Postmortem samples were analyzed to detect alcohols, and prescription and illicit drugs using headspace gas chromatography (HSGC), high performance liquid chromatography (HPLC), and gas chromatography/mass spectrometry (GC/MS) in a forensic toxicology laboratory. Manner of death, demographic characteristics, and different drug categories in postmortem samples were analyzed.

Findings: A total of 1388 poly drug use-associated deaths were investigated during the 6-year study period. Overall, victims were mostly young men of 20-40 years of age (56.8%). The male to female ratio was 7:16. Methadone (n = 660; 47.6%) and amphetamine type stimulants (ATS) (n = 657; 47.3%) were in the highest category for poly drug use-associated deaths. Moreover, in some cases, opium (n = 458; 32.9%), tramadol (n = 389; 28.0%), and tricyclic antidepressants (n = 151; 10.9%) had been used with other drugs.

Conclusion: The present study provides information about poly drug use-associated deaths in Tehran and highlights the major role of substance abuse in death.
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http://dx.doi.org/10.22122/ahj.v13i1.296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080175PMC
January 2021

An alarming rise in the prevalence of deaths with methamphetamine involved in Tehran, Iran 2011-2018.

Forensic Sci Med Pathol 2021 Jun 25;17(2):208-215. Epub 2020 Nov 25.

Forensic Toxicology Department, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.

Methamphetamine is one of the most commonly abused illicit drugs in Iran. Despite this fact, there has been relatively little research on methamphetamine-associated deaths in Iran. The present study aimed to investigate the cause of death in methamphetamine positive cases based on forensic toxicology findings In this data base descriptive study, individuals with methamphetamine-associated deaths that were referred to the Legal Medicine Organization, Tehran, Iran (2011-2018) were assessed. Deaths including those from natural causes, toxicity, accident and suicides with positive forensic toxicology analyses for methamphetamine and its metabolite amphetamine in postmortem samples were investigated. All cases were examined to determine trends in methamphetamine-associated deaths, and in the manner and causes of deaths. During the eight year study there were 1389 methamphetamine-associated deaths. The mean age was 37.47±10.87 years, with a male/female ratio of 12.36:10. The methamphetamine-associated death rate increased significantly during the study period (2.05 vs. 21.93 per 10 Tehran province populations). The most common cause of death was cardiac arrest due to stimulant abuse with supportive histologic findings of acute myocardial infarction, myocardial fiber hypertrophy, aortic dissection and perivascular fibrosis (25%). Opioids (methadone, tramadol and morphine), tricyclic antidepressants and benzodiazepines were frequently present in postmortem samples of study cases. Methamphetamine-associated deaths significantly contribute to illicit drug-associated deaths in Tehran and represent a substantial clinical and public health problem.
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http://dx.doi.org/10.1007/s12024-020-00339-9DOI Listing
June 2021

Effervescent tablet-assisted demulsified dispersive liquid-liquid microextraction based on solidification of floating organic droplet for determination of methadone in water and biological samples prior to GC-flame ionization and GC-MS.

J Sep Sci 2020 Aug 2;43(16):3266-3274. Epub 2020 Jul 2.

Forensic Toxicology Department, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.

A novel effervescent tablet-assisted demulsified dispersive liquid-liquid microextraction based on the solidification of floating organic droplet was developed to determine methadone prior to gas chromatography with flame ionization detection and gas chromatography with mass spectrometry. In this method, a tablet composed of citric acid, sodium carbonate, and 1-undecanol was utilized. The resulting effervescent tablet generated carbon dioxide in situ to disperse 1-undecanol in the sample. Thus, the dispersive and extraction processes were performed in one synchronous step. An aliquot of acetonitrile as the demulsifier solvent was used for the separation of two phases instead of centrifugation. Under optimal conditions, the developed method was linear up to 50 000 µg/L with correlation coefficients higher than 0.99. Moreover, limits of detection and limits of the quantification were in the range of 3-10  and 7-30 µg/L in water and biological samples, respectively. Intra- and interday precisions (n = 6) of the spiked methadone at a concentration level of 50 µg/L were over ranges of 5.1-6.8% and 5.7-7.1%, respectively. The preconcentration factors and recovery values were obtained in the range of 140-145 and 98.1 to 101.6% in real samples, respectively.
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http://dx.doi.org/10.1002/jssc.202000078DOI Listing
August 2020

Evaluation of methanol content of illegal beverages using GC and an easier modified Chromotropic acid method; a cross sectional study.

Subst Abuse Treat Prev Policy 2019 12 16;14(1):56. Epub 2019 Dec 16.

Department of Chemistry, Rasht Branch, Islamic Azad University, Rasht, Iran.

Background: Methanol is highly toxic to human beings and naturally exists in some beverages. Having access to an easy and cheap method for its determination is of great importance to increase the safety of use of these beverages. Our main aim is to evaluate methanol concentration of some alcoholic beverages in Iran black market and compare it with the European and US standards. Also, we evaluated the efficacy of a newly designed and produced chemical kit in determining the risk of methanol toxicity by drinking of such samples compared to gas chromatography method.

Methods: Methanol content of suspected alcoholic beverages referred to forensic toxicology laboratory, Guilan province, Iran was measured using gas chromatography and a recently designed kit based on modified colorimetric chromotropic acid method.

Results: Of 1221 samples, 145 (11.9%) had no ethanol content, while in three samples (0.25%), methanol was high enough (700,000; 870,000; 920,000 mg/L) to cause severe methanol toxicity. Median [IQR] ethanol content of the suspected samples was 9% [3.7, 32.75]. Methanol was detected in 128 (10.48%) samples using gas chromatography method and 160 samples (13.1%) with designed kit with 100% sensitivity, 97.07% specificity, and 100% negative-predictive-value.

Conclusions: Alcoholic beverages produced in local black market in Iran are not safe at all. The application of the new method is practical, rapid, easy, and accurate to evaluate the risk of methanol toxicity in suspected alcoholic drinks.
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http://dx.doi.org/10.1186/s13011-019-0244-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916049PMC
December 2019

Lead Poisoning in Opium-Addicted Subjects, Its Correlation with Pyrimidine 5'-Nucleotidase Activity and Liver Function Tests.

Int J Prev Med 2019 5;10:36. Epub 2019 Mar 5.

Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Background: Lead may be added to the opium by drug smugglers. It can cause elevated blood lead level (BLL) in opium-addicted patients. Erythrocyte pyrimidine 5'-nucleotidase (P5N) activity is susceptible to high BLL. The aim of this study was to find out whether opium-addicted patients show erythropathy and elevated liver enzymes explainable by high BLL and decreased P5N activity.

Methods: Forty orally opium-addicted subjects and 40 normal healthy volunteers were enrolled in this study. BLL was measured in whole blood specimens using atomic absorption spectrometry instrumentation. Enzymatic activity, protein amount of P5N, and erythrocyte purine/pyrimidine ratio were determined. Blood films were analyzed for the presence of basophilic stippling of red cells and hemolytic anemia. The level of liver function enzymes was measured.

Results: The mean BLL for opium-addicted patients was significantly higher than control group ( < 0.001). On the contrary, P5N activity showed a valid decrease in opium-addicted patients when compared with control group ( < 0.001). In line with repressed P5N activity, erythrocyte purine/pyrimidine ratio in patients was lower than control group ( < 0.001). A statistically significant reverse correlation was found between BLL and P5N activity ( < 0.05, = -0.85). The prevalence of both basophilic stippling ( < 0.001, = 6.62) and hemolytic anemia ( < 0.001, = 6.52) in study population was significantly associated with elevated BLL. We could not find any significant correlation between serum level of liver enzymes and BLL.

Conclusions: Opium-addicted patients in Tehran, Iran, are at high risk of lead poisoning which may result in hematologic problems and possibly hepatic damage.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_490_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6425880PMC
March 2019

Determination of synthetic pharmaceutical adulterants in herbal weight gain supplements sold in herb shops, Tehran, Iran.

Daru 2018 Dec 21;26(2):117-127. Epub 2018 Sep 21.

Department of Toxicology & Pharmacology, Faculty of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University (IAUPS), Tehran, Iran.

Background: Nowadays with the growing popularity of herbal remedies across the world, large sections of population rely on herbal drug practitioners for their primary care. Therefore there is a need to ensure about the safety of herbal drugs and to detect adulteration with undeclared active pharmaceutical ingredients. Herbal drugs are used as first-line drug therapy in some instances. Unfortunately even if there are claims as to be natural, undeclared active pharmaceutical ingredients have been detected in these supplements.

Objectives: The purpose of the present study was to analyse herbal weight gain drugs collected from herb shops located in Tehran, Iran to detect hidden pharmaceutical ingredients using UHPLC and GC/MS instrumentations.

Methods: Sixty herbal drugs advertised as weight gain supplements were gathered from herb shops Tehran province, Iran. All samples were analysed from analytical toxicology point of view to detect undeclared active pharmaceutical ingredients. Method was validated for quantitative analysis of cyproheptadine and dexamethasone.

Results: Method validity parameters showed good results for quantitative analysis of pharmaceutical ingredients. Cyproheptadine, dexamethasone, sildenafil, tramadol, caffeine and acetaminophen were detected in herbal weight gain drugs. Analysed dosage forms contained cyproheptadine and dexamethasone in concentrations higher than therapeutic doses. Quantitative analysis of contaminated drugs showed that the content of pharmacologic ingredients were 0.2-67 and 5.5-10.1 mg/tablet or capsule for cyproheptadine and dexamethasone respectively.

Conclusions: Despite natural supplements producers' claim, herbal weight gain drugs were not natural at all. Undeclared active pharmaceutical ingredients can predispose patients to health problems and even life-threatening situations. Graphical Abstract ᅟ.
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http://dx.doi.org/10.1007/s40199-018-0216-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279663PMC
December 2018

The Texture of Psychoactive Illicit Drugs in Iran: Adulteration with Lead and other Active Pharmaceutical Ingredients.

J Psychoactive Drugs 2018 Nov-Dec;50(5):451-459. Epub 2018 Aug 21.

c Department of Medicinal Chemistry, Faculty of Pharmacy , Pharmaceutical Sciences Branch, Islamic Azad University , Tehran , Iran.

Psychoactive illicit drugs are widely used all over the world. Due to the high demand for illicit drugs, adulteration of substances with poisonous and active pharmaceutical ingredients is a common phenomenon in some countries. Lead and other active pharmaceutical ingredients are among adulterants added to illicit drugs intentionally. In the present study, we analyzed four major abused street drugs in Iran's drug black market (opium, Iranian crack, ecstasy tablets, and crystal methamphetamine) to assess active pharmaceutical ingredients and determine a quantitative assay of lead. A total of 40 psychoactive drugs were analyzed using high-performance liquid chromatography, gas chromatography/mass spectrometry, and flame atomic absorption spectroscopy. The results demonstrated that psychoactive drugs were adulterated with different drug categories, such as tramadol, ketamine, methadone, acetaminophen, and caffeine. Lead was found in all analyzed samples, ranging from 9-90 ppm. The smallest lead level was detected in methamphetamine samples. Iranian crack samples contained the highest amount of lead. Psychoactive illicit drugs were adulterated with different drug classes and also lead. Lead-adulterated psychoactive drugs are among the new sources of exposure to lead, while illicit drugs' contamination with different drugs may present a health hazard for drug-abusing patients.
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http://dx.doi.org/10.1080/02791072.2018.1508791DOI Listing
October 2019

Principal component analysis of synthetic adulterants in herbal supplements advertised as weight loss drugs.

Complement Ther Clin Pract 2018 May 15;31:236-241. Epub 2018 Mar 15.

Department of Toxicology & Pharmacology, Faculty of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University (IAUPS), Tehran, Iran.

Objective: Obesity is one of the major problems in many countries. Herbal drugs are widely used to treat obesity. Unfortunately the majority of herbal weight loss drugs are adulterated with active pharmaceutical ingredients. The purpose of the present study was to analyse herbal weight loss drugs for the general search for pharmaceuticals.

Methods: sixty one herbal weight loss drugs that were collected from herb shops and internet in Kermanshah, Iran were analysed qualitatively using gas chromatography/mass spectrometry.

Results: Of the 61 weight loss products sampled, 72% were found to be adulterated with tramadol, caffeine, fluoxetine, rizatriptan, venlafaxine and methadone.

Conclusion: Herbal weight loss products were adulterated with controlled and legitimate drugs. Patients should be aware of the danger of using adulterated supplements.
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http://dx.doi.org/10.1016/j.ctcp.2018.03.007DOI Listing
May 2018

Forensic Toxicology Perspectives of Methadone-associated Deaths in Tehran, Iran, a 7-year Overview.

Basic Clin Pharmacol Toxicol 2018 Apr 15;122(4):436-441. Epub 2017 Dec 15.

Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.

Methadone has a long history of pain relief and successful substitute for maintenance treatment in heroin and narcotic addiction. The aim of the study was to assess the trends of methadone-associated deaths in Tehran, Iran, in 2009-2015, from a forensic toxicology point of view. All methadone-associated deaths during this 7-year study period were evaluated according to demographic parameters and forensic toxicology analysis results. Results showed that 1274 cases of methadone-associated deaths were investigated during the study period. The incidence rate of methadone-associated deaths had risen 7.7 times in 2015 in comparison with 2009 (p < 0.05). The majority of cases were men (90.35%), aged from 20 to 40 years. About 80% of cases had shown positive results for other drugs and poisons in combination with methadone. Methamphetamine and tramadol were the most drugs detected in post-mortem samples. Death rates among methadone users in Tehran, Iran, increased year by year during 2009-2015. These findings raise the attention to the concomitant use of drugs with the need for changes in regulation and regulatory policy to restrict access and use of controlled drugs.
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http://dx.doi.org/10.1111/bcpt.12930DOI Listing
April 2018

Discrimination Between Drug Abuse and Medical Therapy: Case report of a tranylcypromine overdose-related fatality.

Sultan Qaboos Univ Med J 2017 May 20;17(2):e213-e217. Epub 2017 Jun 20.

Department of Anaesthesiology & Critical Care, Tehran University of Medical Sciences, Tehran, Iran.

Tranylcypromine is an effective antidepressant from the class of monoamine oxidase inhibitors and is structurally related to amphetamine. However, reports differ regarding the potential metabolism of tranylcypromine to amphetamine and methamphetamine within the human body. We report a 25-year-old woman with severe depression who died due to a fatal tranylcypromine overdose in 2016. She had been prescribed tranylcypromine one day previously and had no history of previous suicide attempts or substance abuse. The body was transferred to a forensic medicine department in Tehran, Iran for the autopsy. A urine sample was positive for tranylcypromine, amphetamine and methamphetamine using gas chromatography/mass spectrometry after derivatisation with heptafluorobutyric acid. As amphetamines were present in the urine sample, it was assumed that the tranylcypromine had been converted to amphetamines metabolically. As such, it is possible that the legitimate use of certain prescription drugs may complicate the interpretation of test results for illegal drugs.
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http://dx.doi.org/10.18295/squmj.2016.17.02.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488824PMC
May 2017

Discrimination Between Drug Abuse and Medical Therapy: Case report of a tranylcypromine overdose-related fatality.

Sultan Qaboos Univ Med J 2017 May 20;17(2):e213-e217. Epub 2017 Jun 20.

Department of Anaesthesiology & Critical Care, Tehran University of Medical Sciences, Tehran, Iran.

Tranylcypromine is an effective antidepressant from the class of monoamine oxidase inhibitors and is structurally related to amphetamine. However, reports differ regarding the potential metabolism of tranylcypromine to amphetamine and methamphetamine within the human body. We report a 25-year-old woman with severe depression who died due to a fatal tranylcypromine overdose in 2016. She had been prescribed tranylcypromine one day previously and had no history of previous suicide attempts or substance abuse. The body was transferred to a forensic medicine department in Tehran, Iran for the autopsy. A urine sample was positive for tranylcypromine, amphetamine and methamphetamine using gas chromatography/mass spectrometry after derivatisation with heptafluorobutyric acid. As amphetamines were present in the urine sample, it was assumed that the tranylcypromine had been converted to amphetamines metabolically. As such, it is possible that the legitimate use of certain prescription drugs may complicate the interpretation of test results for illegal drugs.
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http://dx.doi.org/10.18295/squmj.2016.17.02.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488824PMC
May 2017

Chemical composition and biological properties of Maroofi.

J Food Sci Technol 2017 Mar 6;54(3):727-734. Epub 2017 Feb 6.

Medicinal Plants and Natural Products Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.

is an indigenous plant which is frequently used as a spice in Avraman-Kurdistan region of Iran. The present study aimed to investigate the chemical composition, antimicrobial and antioxidant properties of the . In addition, rosmarinic acid and total phenolic content of was assessed by spectrophotometric method and HPTLC. The essential oil and methanolic extract were isolated by hydrodistillation and maceration methods, respectively. A total of 32 compounds representing 98.6% of the essential oil were identified by GC-MS and GC-FID. The main constituents were -pentacosane (23.8%), spathulenol (11.5%), β-bourbonen (11.3%) and -docosane (11.0%). The antibacterial activity of samples were carried out by disc diffusion method and evaluate the minimal inhibitory concentration (MIC) essential oil and methanolic extract were found to be effective against , and . The highest scavenging activity was found for methanolic extract of (21.58 µg/mL) and the total phenolics of methanolic extract of was 95.3 mg GAE/g. The rosmarinic acid content of methanolic extract was 0.83 mg/g plant. Antioxidant activity and rosmarininc acid content of suggests that the essential oil and methanolic extract of has great potential for application as a natural antimicrobial and antioxidant agent to preserve food.
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http://dx.doi.org/10.1007/s13197-017-2512-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5334231PMC
March 2017

Histopathological study of cardiac lesions in methamphetamine poisoning-related deaths.

Daru 2017 Feb 17;25(1). Epub 2017 Feb 17.

Tehran University of Medical Sciences (TUMS), Amir Alam Hospital, Tehran, Iran.

Background: Methamphetamine abuse is a worldwide health concern. Methamphetamine causes health hazards in many vital organs. It can cause damage to cardiac tissue via catecholamines release. Methamphetamine related deaths are becoming one of the most important problems in Iran. The purpose of the present study was to determine cardiac pathology in methamphetamine poisoning-related deaths.

Methods: The study included 100 cases of methamphetamine poisoning-related deaths and 100 cases as control group. Toxicology analysis of liver, gastric content, bile, urine, blood and vitreous humor were conducted to detect drugs, poisons and alcohols using thin layer chromatography, gas chromatography/mass spectrometry, and high performance liquid chromatography. Positive toxicology analysis results except for amphetamine and methamphetamine were excluded from the study in order to omit interfering factors. The most striking features of cardiac damage were observed by light microscopy.

Results: Methamphetamine and amphetamine were detected in either urine or gastric content samples. In all of the cases methamphetamine toxicity was determined to be a direct cause of death by forensic medicine practitioner. Cardiovascular pathology was noted in 68% of studied cases. The most common histopathologic features were myocardial fiber hypertrophy, mild, moderate to severe atherosclerosis and focal degeneration/necrosis.

Conclusion: The results of the present study indicate that cardiotoxicity is one of the major contributing factors in methamphetamine poisoning related deaths. Overall, the current study highlights the fact that cardiotoxic effects of methamphetamine can explain increasing reports of heart failure and consequently death in young abusers.

Trial Registration: Not applicable. Histopathological study of cardiac lesions in methamphetamine poisoning-related deaths.
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http://dx.doi.org/10.1186/s40199-017-0170-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5316196PMC
February 2017

Quantitative analysis of benzodiazepines in vitreous humor by high-performance liquid chromatography.

SAGE Open Med 2016 1;4:2050312116666243. Epub 2016 Sep 1.

Legal Medicine Research Center, Legal Medicine Organization, Forensic Toxicology Department, Tehran, Iran.

Objective: Benzodiazepines are frequently screened drugs in emergency toxicology, drugs of abuse testing, and in forensic cases. As the variations of benzodiazepines concentrations in biological samples during bleeding, postmortem changes, and redistribution could be biasing forensic medicine examinations, hence selecting a suitable sample and a validated accurate method is essential for the quantitative analysis of these main drug categories. The aim of this study was to develop a valid method for the determination of four benzodiazepines (flurazepam, lorazepam, alprazolam, and diazepam) in vitreous humor using liquid-liquid extraction and high-performance liquid chromatography.

Methods: Sample preparation was carried out using liquid-liquid extraction with n-hexane: ethyl acetate and subsequent detection by high-performance liquid chromatography method coupled to diode array detector. This method was applied to quantify benzodiazepines in 21 authentic vitreous humor samples. Linear curve for each drug was obtained within the range of 30-3000 ng/mL with coefficient of correlation higher than 0.99.

Results: The limit of detection and quantitation were 30 and 100 ng/mL respectively for four drugs. The method showed an appropriate intra- and inter-day precision (coefficient of variation < 10%). Benzodiazepines recoveries were estimated to be over 80%. The method showed high selectivity; no additional peak due to interfering substances in samples was observed.

Conclusion: The present method was selective, sensitive, accurate, and precise for the quantitative analysis of benzodiazepines in vitreous humor samples in forensic toxicology laboratory.
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http://dx.doi.org/10.1177/2050312116666243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011391PMC
September 2016

Quantitative analysis of benzodiazepines in vitreous humor by high-performance liquid chromatography.

SAGE Open Med 2016 1;4:2050312116666243. Epub 2016 Sep 1.

Legal Medicine Research Center, Legal Medicine Organization, Forensic Toxicology Department, Tehran, Iran.

Objective: Benzodiazepines are frequently screened drugs in emergency toxicology, drugs of abuse testing, and in forensic cases. As the variations of benzodiazepines concentrations in biological samples during bleeding, postmortem changes, and redistribution could be biasing forensic medicine examinations, hence selecting a suitable sample and a validated accurate method is essential for the quantitative analysis of these main drug categories. The aim of this study was to develop a valid method for the determination of four benzodiazepines (flurazepam, lorazepam, alprazolam, and diazepam) in vitreous humor using liquid-liquid extraction and high-performance liquid chromatography.

Methods: Sample preparation was carried out using liquid-liquid extraction with n-hexane: ethyl acetate and subsequent detection by high-performance liquid chromatography method coupled to diode array detector. This method was applied to quantify benzodiazepines in 21 authentic vitreous humor samples. Linear curve for each drug was obtained within the range of 30-3000 ng/mL with coefficient of correlation higher than 0.99.

Results: The limit of detection and quantitation were 30 and 100 ng/mL respectively for four drugs. The method showed an appropriate intra- and inter-day precision (coefficient of variation < 10%). Benzodiazepines recoveries were estimated to be over 80%. The method showed high selectivity; no additional peak due to interfering substances in samples was observed.

Conclusion: The present method was selective, sensitive, accurate, and precise for the quantitative analysis of benzodiazepines in vitreous humor samples in forensic toxicology laboratory.
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http://dx.doi.org/10.1177/2050312116666243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011391PMC
September 2016

Fatal methanol poisoning: features of liver histopathology.

Toxicol Ind Health 2013 Mar 14;29(2):136-41. Epub 2011 Nov 14.

Department of Forensic Toxicology, Legal Medicine Research Center, Tehran, Iran.

Methanol poisoning has become a considerable problem in Iran. Liver can show some features of poisoning after methanol ingestion. Therefore, our concern was to examine liver tissue histopathology in fatal methanol poisoning cases in Iranian population. In this study, 44 cases of fatal methanol poisoning were identified in a year. The histological changes of the liver were reviewed. The most striking features of liver damage by light microscopy were micro-vesicular steatosis, macro-vesicular steatosis, focal hepatocyte necrosis, mild intra-hepatocyte bile stasis, feathery degeneration and hydropic degeneration. Blood and vitreous humor methanol concentrations were examined to confirm the proposed history of methanol poisoning. The majority of cases were men (86.36%). In conclusion, methanol poisoning can cause histological changes in liver tissues. Most importantly in cases with mean blood and vitreous humor methanol levels greater than 127 ± 38.9 mg/dL more than one pathologic features were detected.
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http://dx.doi.org/10.1177/0748233711427050DOI Listing
March 2013

Fatal methanol poisoning: features of liver histopathology.

Toxicol Ind Health 2013 Mar 14;29(2):136-41. Epub 2011 Nov 14.

Department of Forensic Toxicology, Legal Medicine Research Center, Tehran, Iran.

Methanol poisoning has become a considerable problem in Iran. Liver can show some features of poisoning after methanol ingestion. Therefore, our concern was to examine liver tissue histopathology in fatal methanol poisoning cases in Iranian population. In this study, 44 cases of fatal methanol poisoning were identified in a year. The histological changes of the liver were reviewed. The most striking features of liver damage by light microscopy were micro-vesicular steatosis, macro-vesicular steatosis, focal hepatocyte necrosis, mild intra-hepatocyte bile stasis, feathery degeneration and hydropic degeneration. Blood and vitreous humor methanol concentrations were examined to confirm the proposed history of methanol poisoning. The majority of cases were men (86.36%). In conclusion, methanol poisoning can cause histological changes in liver tissues. Most importantly in cases with mean blood and vitreous humor methanol levels greater than 127 ± 38.9 mg/dL more than one pathologic features were detected.
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http://dx.doi.org/10.1177/0748233711427050DOI Listing
March 2013

Current trends in tramadol-related fatalities, Tehran, Iran 2005-2008.

Subst Use Misuse 2010 Nov 15;45(13):2162-71. Epub 2010 Apr 15.

Forensic Toxicology Department, Scientific and Educational Research Center of Legal Medicine Organization, Tehran, Iran.

Tramadol is a widely prescribed drug. Abuse of tramadol as well as tramadol-related deaths have been increasing in Iran. The objective of the present study is to evaluate the trends of tramadol-related deaths that occurred between 2005 and 2008 in Tehran, Iran. Biological samples obtained during the autopsy were analyzed. Tramadol was detected in 294 cases by itself or together with other drugs. The majority of the cases were young male adults. Tramadol-related deaths in 2008 were 32.5 times more than in 2005. These results suggest that tramadol-related fatalities are growing in Iran especially among substance abusers.
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http://dx.doi.org/10.3109/10826081003692098DOI Listing
November 2010

Chemical profile of counterfeit buprenorphine vials seized in Tehran, Iran.

Forensic Sci Int 2007 Oct 23;172(2-3):e4-5. Epub 2007 Jul 23.

Buprenorphine, commonly known by the trademark Temgesic, is one of the most popular drugs of abuse among the opioid-addicted young individuals in Iran. Temgesic, Bungesic, etc. are the most popular and important illicit opioid drugs in Tehran's illicit drugs black market, and are now among the most widely abused by opioid addicts. Because of this, counterfeiting of this drug has increased in Tehran. In this study, the qualitative analysis of counterfeit buprenorphine by gas chromatography-mass spectrometry (GC-MS) and high performance liquid chromatography (HPLC) demonstrates the presence of diacetylmorphine, acetylcodeine and pheniramine, as well as the absence of buprenorphine. In conclusion, due to the absence of quality control and difficulties in differentiating counterfeit buprenorphine from genuine products, the use of counterfeit buprenorphine leads the opioid abusers to health risks.
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http://dx.doi.org/10.1016/j.forsciint.2007.06.016DOI Listing
October 2007

Biochemical evidence for free radical-induced lipid peroxidation as a mechanism for subchronic toxicity of malathion in blood and liver of rats.

Hum Exp Toxicol 2003 Apr;22(4):205-11

Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Organophosphorus compounds may induce oxidative stress leading to generation of free radicals and alterations in antioxidant and scavengers of oxygen free radicals (OFRs). The effect of subchronic exposure to malathion in the production of oxidative stress was evaluated in male Wistar rats. Administration of malathion (100, 316, 1000, 1500 ppm) for 4 weeks increased catalase (CAT), superoxide dismutase (SOD) activities as well as malondialdehyde (MDA) concentration in red blood cells (RBC) and liver. However, acetylcholinesterase (AChE) and cholinesterase (ChE) activities were decreased in these samples. The increase in RBC and liver lipid peroxidation correlated well with the inhibition in RBC AChE and liver ChE activities. Elevation of MDA concentrations and increased activities of CAT and SOD showed significant correlations in both RBC and liver samples when different doses of malathion were used. The results of the present study suggest the usefulness of RBC AChE measurement as a good biomarker in the estimation of malathion-induced oxidative stress affecting blood and liver.
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http://dx.doi.org/10.1191/0960327103ht346oaDOI Listing
April 2003
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